期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 168, 期 4, 页码 3572-3579出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2013.05.068
关键词
Beta-blockers; Heart failure; Side-effects
资金
- British Heart Foundation [FS/10/038]
- British Heart Foundation [PG/11/36/28883, FS/12/12/29294, FS/10/38/28268] Funding Source: researchfish
- National Institute for Health Research [ACF-2009-21-008] Funding Source: researchfish
Background: Patients trying life-preserving agents such as beta-blockers may be discouraged by listings of harmful effects provided in good faith by doctors, drug information sheets, and media. We systematically review the world experience of side-effect information in blinded, placebo-controlled beta-blockade in heart failure. We present information for a physician advising a patient experiencing an unwanted symptom and suspecting the drug. Methods: We searched Medline for double-blinded randomized trials of beta-blocker versus placebo in heart failure reporting side-effects. We calculated, per 100 patients reporting the symptom on beta-blockade, how many would have experienced it on placebo: the proportion of symptoms non-pharmacological. Results: 28 of the 33 classically-described side-effects are not significantly more common on beta-blockers than placebo. Of the 100 patients developing dizziness on beta-blockers, 81 (95% CI 73-89) would have developed it on placebo. For diarrhoea this proportion is 82/100 (70-95), and hyperglycaemia 83/100 (68-98). For only two side-effects is this under half (i.e. predominantly due to beta-blocker): bradycardia (33/100, CI 21-44) and intermittent claudication (41/100, 2-81). At least 6 so-called side-effects are less common on beta-blocker than placebo, including depression (reduced by 35%, p < 0.01) and insomnia (by 27%, p - 0.01). Conclusions: Clinicians might reconsider whether it is scientifically and ethically correct to warn a patient that a drug might cause them a certain side-effect, when randomized controlled trials show no significant increase, or indeed a significant reduction. A better informed consultation could, in patients taking beta-blockers, alleviate suffering. In patients who might otherwise not take the drug, it might prevent deaths. (C) 2013 The Authors. Published by Elsevier Ireland Ltd. All rights reserved.
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